Patient evaluation in idiopathic scoliosis: Radiographic assessment, trunk deformity and back asymmetry

Abstract

Progressive adolescent idiopathic scoliosis (AIS) produces specific signs and symptoms, including trunk and spinal deformity and imbalance, impairment of breathing function, pain, progression during adult life, and psychological problems, as a whole resulting in an alteration of the health-related quality of life. A scoliosis-specific rehabilitation program attempts to prevent, improve, or minimize these signs and symptoms by using exercises and braces as the main tools in the rehabilitation treatment. Patient evaluation is an essential point in the decision-making process and determines the selection of the specific exercises and the specifications of the brace design. However, this article is not addressed to scoliosis management. In this present article, a complete definition and discussion of radiological aspects, such as the Cobb angle, axial rotation, curve pattern classifications, and sagittal configuration, follow a short description of the three-dimensional nature of AIS. The relationship between AIS and growth is also discussed. There is also a section dedicated to the assessment of trunk deformity and back asymmetry. Other important clinical aspects, such as pain and disability, changes in other regions of the body, muscular balance, breathing function, and health-related quality of life, are not discussed in this present article.

Reliability and validity of inexpensive and easily administered anthropometric clinical evaluation methods of postural asymmetry measurement in adolescent idiopathic scoliosis: a systematic review

“…Exclusion criteria were: (1) studies of spinal deformity primarily attributed to a non-idiopathic aetiology (e.g. neuromuscular, neurological, congenital malformation, trauma-related comorbidity), (2) non-healthy subjects (other significant comorbidity of neuromuscular, neurological, congenital or traumatic nature), (3) studies published prior to 1990, (4) papers not available in English language, (5) studies assessing only imaging (MRI and CT scan) or computerised or camera-based topography, (6) validity other than criterion related, and (7) reliability other than inter-observer or intra-observer. A PRISMA flow diagram was used to document the study screening and selection process [25] (Fig.…”

“…AIS is defined as a coronal plane Cobb angle [10° [3,4] and is characterised as: (1) a lateral spinal curvature in the frontal plane, (2) a disturbance of physiological spinal curvatures in the sagittal plane, and (3) an axial rotation of vertebrae in the transverse plane [4].…”

Hypothesis about an existent biomechanical cause–effect relationship between Schëuermann’s kyphosis and scoliosis

“…In a healthy spine, stable equilibrium is reached through the cranial and caudal surfaces of the vertebral bodies, the particular participation of the articular processes, and the intervertebral disć s work in distribution and stabilization. This means that under physiological loading levels, the normal functioning of the elements of these functional units is surpassed, which produces a predisposition toward vertebral alterations [30,[34][35][36].…”

Applicability of the Cobb Angle Measurement in Idiopathic Scoliosis Using Scanned Imaging

“…1 It is known, however, that it is a three-dimensional deviation with components of lateral deviation, deviation in the sagittal plane (deviation from front to back), and rotational deviation of the vertebrae. 2 During the evaluation of a patient with suspected scoliosis, a radiological assessment should be conducted using panoramic radiographs of the spine in posterior-anterior and lateral views in a standing position. This examination is critical for the follow-up of the patient and the choice of the treatment to be implemented.…”

“…This examination is critical for the follow-up of the patient and the choice of the treatment to be implemented. 1,3,4 The key parameter analyzed in the radiographs is the angle of the scoliotic curve, using the most acknowledged method described by 2 Canale and Beaty, 5 Langensiepen et al, 6 and Tanure et al, 7 and still used today to guide clinical follow-up and the proper treatment of the pathology.…”